Provider Demographics
NPI:1528077930
Name:BUTLER, ERIN P (PA C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 NE CUSHING DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3887
Mailing Address - Country:US
Mailing Address - Phone:541-330-8226
Mailing Address - Fax:541-318-0373
Practice Address - Street 1:1253 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1334
Practice Address - Country:US
Practice Address - Phone:541-548-8131
Practice Address - Fax:541-526-6608
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2026363A00000X
ORPA01455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR146958Medicare PIN
ORQ72137Medicare UPIN